Value Viewpoint: January 24, 2025

On Wednesday, ICER announced that their new Launch Price and Access report will replace the long-standing Unsupported Price Increase (UPI) and Fair Access reports.

Numerous stakeholders, including NPC, have repeatedly called for the discontinuation of the flawed UPI report, and I am pleased to see this one sunsetting. I have mixed feelings about the Fair Access report, which had a laudable goal of holding payers accountable for providing “fair” access to patients but never really had the data or visibility to do so.

While it is premature to judge the new report before seeing the proposed methodology, it may suffer from significant blind spots, such as the immaturity of net pricing data adjacent to launch and not including evidence on the holistic value of medicines.

At this time, no protocol is posted, and the timeline on ICER's website only includes the publication of the final report on 2023-2024 drug approvals on October 30, 2025. Let's hope that oversight is remedied soon, and a protocol is posted for public comment.

Two new research articles were published this week in Medical Decision-Making Policy & Practice related to cost-effectiveness analysis (CEA).

1.???? In? Implications of Diminishing Lifespan Marginal Utility for Valuing Equity in Cost-Effectiveness Analysis, study authors explore the inclusion of diminishing marginal lifespan utility (DMLU) in CEA, particularly as it relates to considering equity in CEA. Key takeaways taken directly from the article include:

2.???? In Evaluation of the Soda Tax on Obesity and Diabetes in California: A Cost-Effectiveness Analysis, study authors assessed the cost-effectiveness of a 1-cent-per-ounce soda tax in preventing obesity and diabetes in California. The study found that the soda tax policy prevented 3.28 million cases of being overweight, 0.49 million cases of obesity, and 0.38 cases of diabetes.

They determined that the policy was cost-effective 80% of the time at a willingness-to-pay threshold of $100,000 per QALY. Over a 20-year period, they projected the healthcare system to save $147.39 billion in averted costs, with total tax revenue projected to be $18,609.77 billion.

Here are a few “quick hits” of interest:

• NPC’s John O’Brien sharing his outlook for 2025: 2025 Health Care Outlook: John O'Brien, NPC
• Employers showing interest in alternative PBMs: Industry Voices—Why the great unraveling of PBMs will accelerate in 2025
• HDHP’s impact on patients: How do high-deductible health plans affect patient experience? (includes NPC’s 2022 research on HDHP Good Practices)?
• Brian Reid on Medicare drug negotiations not necessarily saving money for seniors: A Brief Reminder: Medicare 'Negotiations' Alone Don't Really Save Money for Seniors

??? Eye on ICER

A calendar of ICER’s upcoming reports & meetings:

Policy White Papers/Special Assessments:

- 3/4/25: Special Assessment to Inform CMS Drug Price Negotiation: Breo Ellipta and Trelegy Ellipta — Final Report

- 10/30/25: Launch Price and Access Report: Drug Approvals from 2023-2024 — Final Report

Value Assessment Reports:

- 2/5/25: Acute Pain — Revised Evidence Report

- 2/6/25: Retinitis Pigmentosa — Draft Evidence Report

- 3/26/25: Retinitis Pigmentosa — Revised Evidence Report

- 3/27/25: Acute Pain — Final Evidence Report

- 4/10/25: Multiple Sclerosis: SPMS — Draft Evidence Report

- 5/12/25: Retinitis Pigmentosa — Final Evidence Report

- 5/27/25: Spinal Muscular Atrophy — Draft Evidence Report

- 5/29/25: Multiple Sclerosis: SPMS — Revised Evidence Report

- 7/15/25: Multiple Sclerosis: SPMS — Final Evidence Report

- 7/17/25: Spinal Muscular Atrophy — Revised Evidence Report

- 9/2/25: Spinal Muscular Atrophy — Final Evidence Report

Meetings:

- 2/28/25: Acute Pain — Public Meeting (Midwest CEPAC)

- 4/11/25: Retinitis Pigmentosa — Public Meeting (New England CEPAC)

- 6/13/25: Multiple Sclerosis: SPMS (California Technology Assessment Forum CTAF)

- 8/1/25: Spinal Muscular Atrophy — Public Meeting (Midwest CEPAC)

Contributing author: Brian Sils